National Defence Committee on Feb. 14th, 2008

[The Chair, Conservative, Rick Casson]

The witnesses are in place. We have a quorum. I call the meeting to order.

This is meeting 13 under our motion to study health services provided to the Canadian Forces personnel, with an emphasis on post-traumatic stress disorder.

Today we have Commander Briggs, who is the medical advisor to the Chief of the Maritime Staff; Colonel Darch, medical advisor to the Chief of the Land Staff; and Captain Courchesne, medical advisor to the Chief of the Air Staff. We welcome you all.

The process is usually to allow you the time to make a presentation. I understand you all have one, whatever time that takes. We'll start a round of questioning thereafter.

I understand, Commander, you are going to start. The floor is yours.

[Commander R.P. Briggs, Medical Advisor to the Chief of the Maritime Staff, Department of National Defence]

Thank you.

Thanks for the invitation to appear before your committee to discuss maritime health service support issues.

As an introduction, my name is Commander Rob Briggs. During my career I have served primarily in the navy environment, though I've also spent considerable time with the army. I've had operational deployments in both environments and have completed postgraduate training in public health and hyperbaric medicine—diving and undersea medicine.

My title is director, maritime health services, and CMS—which stands for Chief of the Maritime Staff—medical advisor. My primarily roles are as follows. I provide professional, technical, or clinical advice to the Chief of the Maritime Staff on all aspects of health service support pertinent to navy personnel, platforms, equipment, and navy operations. I act as the CMS' senior authority on all issues pertaining to occupational health.

In the role of director of maritime health services, I act as an advocate to ensure that the health requirements of the navy are met by a centralized CF health services group. I also provide advice to the Surgeon General and senior Canadian Forces health services staff on navy priorities and strategic direction as they will impact on current and future health service delivery and force health protection.

I am the Surgeon General's senior advisor on all issues pertaining to navy occupational health, including submarine and diving medicine. I serve as a clinical conduit, if you will, between the Surgeon General and the regional surgeons in Esquimalt and Halifax for all clinical issues. Where required, I modify CFHS policy and provide advice on program delivery to reflect the operational and occupational requirements of the navy.

It is important to appreciate that I serve a staff and not a line function within the Maritime Staff and Canadian Forces health services group headquarters. By that, I mean that I do not command the CF health care centres on either coast. They are commanded by clinic managers, who in turn report to one health services group for Esquimalt—which is located in Edmonton—and four health services group headquarters for Halifax—which are located in Montreal.

As a staff officer, I monitor professional, technical, and clinical aspects of health programs and health care delivery as delivered by all health care providers providing operational or operational readiness care to navy personnel.

The navy has historically played a large role in maintaining Canada's sovereignty and security and projecting Canada's foreign policy goals abroad. Since 1990, the navy has participated in many UN, NATO, and other operations in southwest Asia, Somalia, Haiti, the Adriatic Sea, East Timor, and in aid of our southern neighbours following devastating hurricanes. In addition, the navy has responded to domestic missions, including the Swiss Air recovery, the GTS Katie boarding, drug interdictions, fishery patrols, etc.

As you know, the navy has played a major role in CF operations since 9/11. During Operation Apollo, Canada deployed 15 of the 17 major naval warships, comprising 96% of our total seagoing positions, to southwest Asia. The navy's presence there continues to this day. HMCS Charlottetown is currently deployed, and HMCS Toronto recently returned from an operational deployment in that area.

In addition, navy augmentees are presently fulfilling important roles in Afghanistan. On a daily basis, clearance divers, naval boarding party members, Sea King air crew, and explosive ordnance disposal experts place themselves at risk on behalf of Canada.

It is important for the committee to understand that the complement of health service support personnel on a frigate or destroyer at sea comprises only two persons: a physician assistant and a medical technician. The ship may be as far as a seven days' sail from land at times, so these personnel must be extremely well trained and well equipped and be independent thinkers. Needless to say, there is a great deal of responsibility on their shoulders, and they are extremely valuable assets to the CFHS and the navy.

A number of issues improve the navy's capability of delivering health care support to their personnel. I will touch on only a couple here.

The navy practice of maintaining home port divisions maintains stability and support for family members of sailors away on deployment or courses.

The navy personnel enjoy a great deal of buy-in and support from the navy chain of command at the highest levels, at the formation commander's level on each coast, and CMS, which is ultimately responsible for the health and well-being of their sailors, soldiers, airmen, and airwomen.

I'm telling the committee this as a reminder of the importance of ensuring that, whatever recommendations come out of the committee's good work, you involve the navy and ensure that the navy is factored into any of the recommendations that are forthcoming.

I would be pleased to answer any of your questions following the other opening addresses.

Thanks very much.

[The Chair, Conservative, Rick Casson]

Thank you.

Who's next?

Go ahead, please.

[Captain, N) M.E.C. Courchesne (Medical Advisor to the Chief of Air Staff, Department of National Defence]

Mr. Chairman and members of the committee, I'm Captain (Navy) Cyd Courchesne, the medical advisor to the Chief of the Air Staff, and the director of aerospace medicine for the Canadian Forces.

I would like to provide a brief background and explain the roles and responsibilities of my position. I'm a general practitioner by training, and I enrolled as a general duty medical officer in the CF and completed post-graduate training in aviation medicine. Most of my career has been spent in support of the air force. I first started out as a flight surgeon in Cold Lake, Alberta, and progressed over the years to my position as medical advisor to the Chief of the Air Staff.

Although it might seem strange to you that I'd do this in a naval dress uniform, that is just a reflection of the joint nature of the CF.

Like my colleagues present here, in general terms, I'm the liaison between the air force and the health services group. I provide advice to the Chief of the Air Force and his staff on medical matters, and I am the point of contact for the air force headquarters staff for issues related to health services. Likewise, I provide the commander of the health services and our senior staff with advice, information, and situational awareness on the air force and air force issues.

I provide professional technical guidance and leadership to all the regional surgeons in matters of aerospace medicine support, though I have no command authority over them. I function as a senior staff officer of the health services group, and I represent Canada in international military aerospace medicine working groups.

I have no direct role in the health service delivery at the clinical level or on deployments, and no direct role, either, in the mental health realm, whether that be programs, policy, or service delivery.

As director of aerospace medicine, I'm responsible in general terms for formulation of doctrines, strategic plans, and policies with respect to health services support to air operations. In particular, I establish air crew medical standards and air crew medical policy for the Chief of the Air Staff and for the CF.

I also hold the appointment of medical advisor to the airworthiness authority under the Aeronautics Act, and that just also happens to be the Chief of the Air Staff.

I will be pleased to answer your questions in French or English. Thank you.

[The Chair, Conservative, Rick Casson]

Thank you very much.

Go ahead, Colonel.

[Colonel A.G. Darch, Medical Advisor to the Chief of the Land Staff, Department of National Defence]

Mr. Chairman and members of the committee, thank you for inviting me to appear before you today.

I am Colonel Allan Darch, the medical advisor to the Chief of the Land Staff.

I'd like to briefly explain my background and the roles and responsibilities of my current position. I feel that it's important to note that I do not have a direct role in mental health care, and I do not work specifically on occupational stress injuries or on PTSD.

As a doctor, I'm a general practitioner by training, and most of my career has been spent providing medical support to the army. During my career I've had four operational deployments. I started as the unit medical officer for a mechanized infantry battalion—and I'm very pleased to see my first commanding officer here today, General Cox. I gradually progressed over the years to my current position as the medical advisor to the Chief of the Land Staff.

In broad terms, I'm the liaison between the army and the health services group. More specifically, I advise the commander of the army and his senior staff on medical matters, and I'm the point of contact for the senior army headquarters staff for matters related to health services. I also function as senior staff officer for the land staff. Parallel to this, I provide the commander of the health services group and her senior staff with advice, information, and situational awareness on the army, and I'm their point of contact for army-related medical issues. I also function as a senior staff officer within the health services group and represent Canada on international military health care working groups.

Additionally, I provide medical, professional, and technical guidance and leadership to the four army regional surgeons, although I do not have a command and control relationship over them.

I'm also the military occupation advisor for general duty medical officers. In this role, I'm responsible for the coordination and control of where medical officers are employed across Canada and I contribute to their career management. As part of this, I chair the post-graduate training board and participate in merit boards.

To assist me, I have a staff of one subordinate, a major, who is a health service officer.

I welcome your questions.

[The Chair, Conservative, Rick Casson]

Thank you all very much.

I'll mention before we get started that you recognized our researcher. I understand that at one point in time you had to patch him up a little bit. We thank you for doing that so he's able to be with us.

Mr. Coderre will start our questioning with a seven-minute round.

[Denis Coderre, Liberal, Bourassa, QC]

Thank you very much, Commander, Captain, and Colonel.

This is probably one of the most sensitive and important issues in relation to the condition of our troops. Of course, there's a lot of prevention, but there's a matter of cure.

As a start, it would be important to talk about the status. I know from a medical health journal today that when they studied data in over 8,000 files, they said that half of the people who have post-traumatic stress disorder don't even look to get some treatment. That's my first point. I would like some of you to talk about that.

I would like to know specifically the status regarding our forces. Maybe we should talk about the issue of post-traumatic stress disorder, but there are also other issues, such as addiction to drugs and alcohol and all that. I'm wondering how our troops are.

Secondly, I was a bit troubled by an answer from General Jaeger when we were talking about providing some medication to some of our soldiers and bringing them back on the field. I won't get specific now, but if we can address those two issues, I would be pleased.

[The Chair, Conservative, Rick Casson]

Is there anybody who wants to take a shot at that?

Go ahead.

[Capt(N) M.E.C. Courchesne]

I'm not sure what the question is. Could you...?

[Denis Coderre, Liberal, Bourassa, QC]

I can repeat it in French, if you like.

It's not a complicated question: according to a study involving some 8,000 individuals, half did not request treatment, and yet post-traumatic stress syndrome is a growing problem. I would like to know what the current situation is as regards our troops. How is it going in the field, whether it be the Navy, the Air Force or the Army?

The other problem is that General Jaeger told me right here in this Committee that people were treated and then sent back to the front line while still under medication. I would like to get further information about that. Then we can talk about more specific issues.

[Capt(N) M.E.C. Courchesne]

On the first part of your question, I'm not sure I know what you're referring to--this study of 8,000 people.

[Denis Coderre, Liberal, Bourassa, QC]

A medical health journal, which is a--

[Capt(N) M.E.C. Courchesne]

I'm not familiar with that study, so I don't feel comfortable commenting on the--

[Denis Coderre, Liberal, Bourassa, QC]

Basically, they were saying that although we have a lot of people who need treatment, half of them don't even seek it, so what are we going to do about it, in the prevention--

[Capt(N) M.E.C. Courchesne]

In general terms, if we're talking about mental health, it's general medical knowledge that a large percentage of individuals do not seek medical help, basically because they are in denial about their symptoms or because there is a lot of stigma attached to mental health problems. I think that's generally well known.

I would say it's a matter of education in the Canadian population as well as in the Canadian Forces as to the resources we have with respect to treatment for mental health and destigmatizing mental health.

[Denis Coderre, Liberal, Bourassa, QC]

What would you do as an advisor, then, to seek out those people, to make sure they know it is normal that they might have some problems, and that we are there to help them?

[Capt(N) M.E.C. Courchesne]

I would defer that to our mental health colleagues responsible for formulating programs with respect to the delivery of mental health care services.

[Denis Coderre, Liberal, Bourassa, QC]

How about the issue of medication and what kind of medication we provide to those soldiers who are going back to the front?

[Cdr R.P. Briggs]

Sir, if I could briefly go back to your first question, there's no doubt that the stigma of mental health is a big issue, not only within the CF but within the greater Canadian community. It is very hard to break those barriers down.

A lot of it is perception of the individual, so that does produce problems. We can have all sorts of services, but if people don't identify themselves or aren't identified, it's hard to give them treatment, and that is an issue we wrestle with.

We have done some things. For example, our new health assessment, which is about to be unrolled, is going to be every two years. Formerly, every five years CF members up to the age of 40 needed to get a physical examination per se, which involved a history and a physical exam. Then from age 40 to 50 it was every two years, and thereafter it was every year.

The advice of our subject matter experts has indicated that we're much better off from the get-go to do this every two years. As part of this, not only are we increasing it to every two years, but our experts have weighted in a variety of screening questions, on not only physical health but also mental health.

We would hope that in effect by doing this every two years we would identify folks who are in some sort of physical or mental distress. That's one way we have of perhaps reaching out a little more frequently to hopefully identify these folks.

I think the committee is already aware, because of testimony, that we have an enhanced post-employment screening process now, which, as far as I can tell--and again, I'm not a mental health expert--is the premier post-deployment process that any military has in the world. From what I'm told, it's even superior to what the U.S. system has in place.

We're ideally catching everybody from a deployed operation abroad. Within three to six months of their return from a deployment, we're doing an enhanced screening process, as part of which there is a questionnaire and an actual interview with a mental health professional. That's supposed to be ensured through the chain of command. The chain of command will tell Corporal Bloggins, “You have to go in on this date for your enhanced post-deployment questionnaire.”

[Denis Coderre, Liberal, Bourassa, QC]

But they don't do that if they're going back to the field?

[Cdr R.P. Briggs]

Everybody should undergo this process regardless.

[Denis Coderre, Liberal, Bourassa, QC]

Do we have a lot of cases? I was doing some reading about medical treatment with medications such as Zoloft and Paxil, for those people who suffer with that disorder. What is the side effect of putting somebody on medication in a theatre of operation?

[Cdr R.P. Briggs]

I would say generally our philosophy—and this is a general rule—is that if the interruption of a medication is going to cause an acute exacerbation of physical or mental symptoms, then someone is non-deployable at that point. There are a lot of other parameters as well, but I'm talking from a medical point of view, about a medical problem.

The other issue is whether that medication affects your cognitive abilities. For example, if you're supposed to be officer of the watch on a ship and you're going to be drowsy and fall asleep, or if you're going to be sentry and you fall asleep, or you could have a convulsion, or if side effects from that medication will affect your ability to look after yourself and your buddies, then at that point you would not be able to be deployed using that medication. Medications vary.

[The Chair, Conservative, Rick Casson]

Sorry, but we'll come back to that later. We're way over time. We have lots of time. You'll get another shot in.

Mr. Bouchard, before we proceed with you, can you update us on Mr. Bachand? I understand he was walking around on crutches. Is he okay? Can you explain what happened to him?